About Global Pharmaceutical Solutions (GPS)
Global Pharmaceutical Solutions (GPS) delivers consulting and administrative support services to corporate and union plan sponsors, health care systems and managed care organizations. The firm’s partners possess extensive experience, with backgrounds in Medicare, pharmacy consulting, medical administration, data analytics, underwriting, information technology, and vendor performance management.
GPS possesses many qualifications, including the following:
• GPS offers a comprehensive suite of products and services to support the design, implementation, management and administration of pharmacy benefit programs.
• GPS staff possesses considerable knowledge of PBM systems and operations having audited numerous national, regional and local PBMs throughout their consulting careers. In addition, GPS staff has performed independent assessments of most pharmacy claim adjudication systems utilized throughout the PBM industry.
• GPS staff has performed audits that have resulted in successful recovery of overpayments.
• GPS consultants have successfully implemented operational improvements to correct administrative deficiencies to maximize the sentinel effect derived from various services.
• GPS has developed innovative and effective Medicare solutions for our clients, including full support services for Medicare RDS programs, Commercial PDPs and MA-PDs and Employer Group Waiver Plans (EGWP) Direct and “800 Series” Plans.
• GPS staff possesses extensive knowledge of the requirements and sub-regulatory guidance that have been promulgated by the Centers for Medicare and Medicaid Services (CMS).
• GPS consultants have participated in CMS sponsored training programs and focus groups related to PDP/MA-PD, EGWP (“800 Series” and Direct) and RDS administration and compliance.
• GPS consultants have audited commercial Medicare PDP and MA-PD prescription drug administrators’ PDE reporting processes for compliance with CMS requirements and sub-regulatory guidance.
• GPS staff has worked with Medicare Integrity Contractors (MEDIC) to provide guidance for monitoring fraud, waste and abuse within the administration of the Medicare Part D program.
• GPS staff have worked for CMS and participated on teams responsible for a variety of activities which included writing a portion of the Medicare Part D regulations, development of the agency’s policies regarding administration and compliance for Part D programs, development of policies, practices and procedures related to Medicare Secondary Payer rules, development of CMS audit guides and Standard Operating Procedures for use in analyzing and evaluating the Employer Policy & Operations Group's functions and serving as a CMS liaison for employer/union health plan issues with Federal and State entities, national organizations, advocates, and private industry.
• GPS consultants have implemented and administered Medicare programs including:
- Medicare RDS programs with services including application and related maintenance, eligibility submissions and maintenance, communications, interim cost report generation and submissions, reconciliation activities, over/under payment identification as well as auditing and compliance.
- Employer Group Waiver Plan (EGWP) direct contract Medicare Prescription Drug Plans (PDP) with services including program operations and administration, bid and application development and submission, eligibility maintenance and error resolution services, prescription drug event data (PDE) development, submission and maintenance services, reconciliation activities, communications and document development, full-scope compliance program administration including auditing.
- “800 Series” EGWPs offering enhanced benefit arrangements with services including program bidding and placement, implementation, integration of alternate funding arrangements, program performance and renewal negotiations and contracting.
GPS has also developed a suite of administrative solutions and support services which enable our clients to objectively choose from among all Medicare Part D approaches and select the option best suited to the client’s needs, knowing that the selected approach can be administered in compliance with regulatory requirements.
